Provider Demographics
NPI:1669457669
Name:WILSHIRE HEALTH SERVICES INC
Entity Type:Organization
Organization Name:WILSHIRE HEALTH SERVICES INC
Other - Org Name:COSMOPOLITAN HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-380-3990
Mailing Address - Street 1:3699 WILSHIRE BLVD
Mailing Address - Street 2:STE 1280
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010
Mailing Address - Country:US
Mailing Address - Phone:213-380-3990
Mailing Address - Fax:213-380-4210
Practice Address - Street 1:3699 WILSHIRE BLVD
Practice Address - Street 2:STE 1280
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010
Practice Address - Country:US
Practice Address - Phone:213-380-3990
Practice Address - Fax:213-380-4210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA057470Medicare ID - Type Unspecified